Organization
LAKELINE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMITA PRAKASH DDS (DENTIST)
(512) 659-6968
Entity
Organization
Contact information
Practice address
1201 N LAKELINE BLVD, SUITE NUMBER 300, CEDAR PARK, TX 78613-6781
(512) 937-3371
Mailing address
1201 N LAKELINE BLVD, SUITE NUMBER 300, CEDAR PARK, TX 78613-6781
(512) 937-3371
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22965
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183706402
—
TX
Enumeration date
09/23/2014
Last updated
09/23/2014
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